Advances in research of paravertebral muscle changes after lumbar fusion
10.3760/cma.j.cn121113-20240122-00049
- VernacularTitle:腰椎融合术后椎旁肌改变的研究进展
- Author:
Huaqing ZHANG
1
;
Cailiang SHEN
Author Information
1. 安徽医科大学第一附属医院骨科-脊柱外科，合肥 230022
- Keywords:
Lumbar vertebrae;
Spinal fusion;
Paraspinal muscles;
Review
- From:
Chinese Journal of Orthopaedics
2024;44(19):1300-1304
- CountryChina
- Language:Chinese
-
Abstract:
Lumbar fusion remains a widely used procedure in clinical practice; however, both patients and clinicians often face challenges related to chronic low back pain and adjacent segment degeneration following traditional open lumbar fixation and fusion. Recent studies have demonstrated that these complications are associated with muscle ischemia and denervation caused by intraoperative dissection and traction of the paravertebral muscles. The postoperative mass of the paravertebral muscles has also been proposed as a predictor of surgical outcomes. With advancements in minimally invasive spinal techniques, minimally invasive lumbar fusion has gained increasing clinical application, drawing more attention to its impact on the paravertebral muscles. After lumbar fusion, the paravertebral muscles undergo a series of histopathological and morphological changes. Traditional open lumbar fusion can exacerbate the natural degeneration of paraspinal muscles, manifesting histopathologically as multifidus muscle edema, an increase in opaque fibers, muscle fiber necrosis, and infiltration of fat and connective tissue. Denervation and a reduction in motor units have been observed through electromyography, while imaging has revealed reduced muscle volume and strength. Different lumbar fusion techniques exert varying effects on the paravertebral muscles. Compared to traditional lumbar fusion, approaches such as the paramedian interfascial approach (PIA), multifidus muscle bundle (MMB) approach, minimally invasive transforaminal lumbar fusion (MIS-TLIF), and cortical bone trajectory screw techniques reduce iatrogenic paravertebral muscle injury. Moreover, anterior lumbar interbody fusion, oblique lateral interbody fusion, lateral lumbar interbody fusion, and endoscopic posterolateral transforaminal lumbar interbody fusion can significantly minimize or even prevent paravertebral muscle injury, leading to improved clinical outcomes.
